心境障碍(英文)

even stupor. In severe cases , psychotic symptoms, such as delusions and hallucinations, may be present.
Epidemiology
Symptoms and disorders of the depression spectrum are rather common. Lifetime prevalence rates for depressive symptoms are 13%~20% and for major depressive disorder 3.7%~6.7% . Major depressive disorder is about two to three times as common in adolescent and adult females as in adolescent and adult males. In prepubertal children, boys and girls are affected equally. Rates in women and men are highest in the 25-to44-year-old age group.
The episode Severity Type Special features Mild, moderate, or severe Depressive, manic, mixed With melancholic symptoms With neurotic symptoms With psychotic symptoms With agitation With retardation or stupor Unipolar or bipolar Predominantly reactive Predominantly endogenous
Biological theories
Neurotransmitters.
We now know that all clinically effective antidepressants increase neurotransmitter concentrations at postsynaptic receptor sites by inhibiting their reuptake (into the presynaptic neuron) from the synaptic cleft, This action has led to the hypothesis that depression is caused by a neurotransmitter deficiency and that antidepressants exert their clinical effect by treating this imbalance.
cortisol hypersecretion that returns to normal once
the depression is cured.
Life events
Recent evidence confirms that crucial life events,
particularly the death of loss of a loved one , can precede the onset of depression. However, such losses precede only a small number of cases of depression.Fewer than 20% of individuals experiencing losses become clinically depressed . These observations argue strongly for a predisposing factor, possibly genetic , psychosocial,or characterological in
other words , single major genes are
important in at least some families, but it is
not the same gene in each family.
Twin studies:
On average, MZ twin pairs show
in psychiatry are the hypothalamic-pituitary-adrenal
(HPA) axis and the hypothalamic-pituitary-
thyroid (HPT) axis.
About half of patients with major depression exhibit
Linkage Studies Chromosomal Location 18p 21q Xq26 11p15 Reference Berrettini et al 19 Stine et al 1995 Straub et al 1994 Detera-Wadleigh et al 1996 Pekkarinen et al 1995 Egeland et al 1987 Kelsoe et al1991 Gurling et al1995 Coon et al 1993 Blackwood et al 1996 Freimer et al 1996 Stine et al1995 Craddock et al1994 Ewald et al 1995 Ginns et al 1996 NIMH Genetics Initiative 1997
Adoption studies that used a broader class of affective probands showed evidence for genetic factors but also possible environmental influences.
Molecular Genetics
5q 4p 18q Other (including 10p,12q)
Sumk for severe affective disorder is about 8%. Risk is increased to about 20% in first-degree relatives of unipolar patients and to 25% in first-degree relatives of bipolar patients. Risk appears to be 40% in relatives of schizoaffective patients. The risk to offspring of two affectively ill parents is more than 50%. Overall risk figures appear to be rising in recent years.
The Classification of Affective Disorders
Manic episode (mania) Depression (unipolar) With or Affective without
single episode recurrent episode
Disorders Psychotic Bipolar disorders
Bipolar-I(with mania) Bipolar-II(with hypomania) symptom Mixed type Rapid-cycling
bipolar disorder Dysthymia Cyclothymia disorder
Clinical description of mood disorders
The serotonin-norepinephrine-glucocorticoid link hypothesis of affective disorders.
Neuroendocrine factors.
The two endocrine systems most extensively studied
concordance 65% of the time, and DZ twin pairs show concordance 14% of the time.
Adoption Studies:
In one study , the risk for affective disorder in the biological relatives of bipolar probands was 31% as opposed to 2% in the relatives of control probands. The risk in biological relatives of adopted bipolar probands was similar to the risk in relatives of bipolar probands who were not adopted away (26%). Adoptive relatives did not show increased risk.
nature.
Depressive episode
Definition The disorder is characterized by depressed mood
that is out of keeping with the circumstances. It
may vary from low mood to melancholia, or
Some data have supported multifactorial
models , These models imply multiple